Archived: Dr Stephen Carr Also known as Bank Street Surgery

Updated 7 March 2017

The practice is located in Bank Street Surgery, Keswick and provides primary medical services to patients living in Keswick in the Allerdale area of Cumbria. The practice provides services from one location at 9 Bank Street, Keswick, Cumbria, CA12 5JY, which we visited during this inspection.

The practice is based in converted premises in the centre of Keswick. The building is split into two parts with no clinical services provided in the annex. There is no on-site parking or disabled parking but this is available within a short walk from the practice. A disabled WC is available in the annex. A ramp ensures access to the ground floor clinical rooms. Nursing appointments are held on the first floor via a set of stairs, a ground floor room can be used for nursing or other appointments when required by patients.

The practice has one male GP. The practice employs a practice manager, two practice nurses, a medicines manager and one health care assistant who also undertook a secretarial role. There are four members of staff who carry out administrative or reception duties, a notes summariser and a cleaner. The practice provides services for around 1,700 patients based on a General Medical Services (GMS) contact.

The practice is open from 8am to 6:30pm Monday to Friday. On Wednesday the practice offers extended hours and closes at 7pm. Appointments are available with the GP, nurse or health care assistant.

Information from Public Health England placed the area in which the practice was located in the ninth less deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice’s age population is weighted towards people over the age of 45.

The service for patients requiring urgent medical care out of hours is provided by the 111 services and Cumbria Health on Call Limited (CHOC).

Updated 7 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Stephen Carr on 5 November 2015. The overall rating for the practice was good, although the practice was rated as requires improvement for safety. The full comprehensive report on the November 2015 inspection can be found by selecting the ‘all reports’ link for Dr Stephen Carr on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 5 November 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for safe services, and overall the practice is rated as good.

Our key findings were as follows:

• The practice had taken action to address the concerns raised at the CQC inspection in November 2015. They had put measures in place to ensure they were compliant with regulations.
• Appropriate checks were now carried out on new staff employed by the practice, including locum GPs.

• The process for monitoring the storage and use of controlled drugs at the practice was now regularly followed.
• A system for tracking prescription pads and paper through the practice was now in use.
• At the November 2015 inspection we told the practice they should review governance arrangements to ensure the practice policies and procedures were up to date and reflected current guidance. We found that the practice were now doing this.

The practice showed us evidence of other improvements they had made since the inspection in November 2015. This included reflecting on positive significant events, using text messages for health promotion campaigns (such as smoking cessation), and implementing alerts on the practice computer system to help staff monitor and review the needs of patients with dementia.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 March 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice held an unplanned admissions register.

• Nationally reported data showed that outcomes for patients with long term conditions were good. For example, the practice had achieved 97.7% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was above local CCG average of 93.6% and the national average of 89.2%.

• Care plans were used by the practice to ensure effective care and to support self-management. For example, when patients were deemed at risk of admission to hospital.
• Longer appointments and home visits were available when needed.
• All these patients were offered a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice met with district nurses on a regular basis.

Updated 16 March 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• We saw that staff treated children in an age-appropriate way and were recognised as individuals.
• The practices uptake for cervical screening was 83.5% which was in line with the local CCG average of 82.5% and the national average of 81.8%.
• Appointments were available outside of school hours and the premises were generally suitable for children and babies. 
• We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 16 March 2016

The practice is rated as good for the care of older people.

• The practice offered effective care to meet the needs of the older people in its population.
• They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This was acknowledged positively in feedback from patients and the patient participation group.
• The practice held monthly advice sessions provided by nationally recognised organisation that supported older people. This was advertised in the local press and the practice newsletter.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example, the practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with heart failure. This was similar to the local CCG average of 99.6% and above the national average of 97.9%.

Updated 16 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice population greatly increased in the summer months when the practice registered a large number of patients who were working temporarily in the area.
• The practice was proactive in offering online services as well as a range of health promotion and screening that reflects the needs for this age group.

• Extended opening hours for appointments were available each Wednesday until 7pm; appointments were available with a GP, nurse or healthcare assistant.
• Patients could book appointments and order repeat prescriptions online. The practice planned to improve the online services they provided.
• Additional services such as health checks for over 40’s were provided.
• Text messages were used to remind patients of appointments if requested.

Updated 16 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice held a register of patients experiencing poor mental health, 67% of the patients on this register had attended an annual health check in the last year.
• Nationally reported data showed that outcomes for patients with mental health conditions were generally comparable to local and national averages. For example, the practice had achieved 88.5% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was below the local CCG average of 95.4% and the national average of 92.8%.
• Nationally reported data showed that outcomes for patients with dementia were good. For example, the practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was above the local CCG average of 95.7% and the national average of 94.5%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• They carried out advance care planning for patients with dementia.
• The practice advised patients experiencing poor mental health how to access various support groups and voluntary organisations. They also worked well with the local mental health team.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 16 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The number of patients with a learning disability was very low. The GP told us that no patients on this register were recorded as being homeless or having issues with drug addiction.
• They offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. For example, the practice met with district nurses on a regular basis.
• They gave vulnerable patients advice about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• A service for those experiencing depression and anxiety disorders held talking therapies sessions at the practice three days a week, this included time for patients not registered at the practice.